Know the Difference: Psychogenic Non-Epileptic Seizures or Epileptic Seizures

October 20, 2020

Psychogenic Non-Epileptic Seizures (PNES) can look like epilepsy. For the sake of one’s journey with a seizure disorder, it is important to know the difference.

The movements or altered awareness that we see in epileptic seizures are caused by abnormal electrical patterns in the brain. While PNES can have similar movements and altered states, the causes are rooted in psychological or emotional stressors, and the brain does not have the same electrical patterns.

PNES can be caused by previous traumatic psychological experiences. Although traumatic experiences can often be forgotten, the psychological impact can still trigger seizures. When EEG video monitoring is used to assess a seizure, Psychogenic Non-Epileptic Seizures do not show spike and wave patterns as epileptic seizures would.

People can have both Psychogenic Non-Epileptic Seizures and epileptic seizures. 

PNES can be misdiagnosed as epilepsy. Up to 40 percent of those assessed in Ontario Epilepsy Monitoring Units have PNES. These patients may also have epilepsy, but that’s not always the case.

Misdiagnosis has its risks. Dr. Tad Fantaneanu (Dr. Tad), Director of the Adult Epilepsy Program at The Ottawa Hospital explains, “The biggest danger is that [patients with PNES] are exposed to medications that carry the risk of side effects and that won’t treat their condition. The delay in diagnosis or misdiagnosis also means they’re not getting the treatment they need to heal and get better.”

Similar to epilepsy, the general public does not know much about PNES. Even some health care professionals disregard the seriousness of a patient’s seizures if they are not epileptic seizures. They mistakenly believe that patients are faking the seizures or can control their seizures because PNES results from trauma’s effect on mental health – which is a topic with its own stigma.

“It’s difficult for people to grasp that patients who have convulsions as part of their PNES manifestations, for example, can’t stop on their own, or have little to no insight into their condition” explains Dr. Tad. “Yet that is exactly what happens to these patients: their minds create an unhealthy connection between emotional centers in their brain and centers that deal with movements or consciousness/ awareness.”

There are only a handful of specialists in the Ottawa area capable of recognizing and treating PNES. Counseling or cognitive behavioural therapy to treat the root cause of one’s seizures can help. Therapy is usually costly, but according to Dr. Tad, there are still some helpful and affordable options available in the area. 

“The treatment options often rely on behavioral modification, which means, in essence, retraining the brain by rewiring it as it were to prevent these attacks. This can be achieved through a number of ways but the best studied is through a process called cognitive behavioral therapy. There can be group session options for mental health that can be accessed through a TOH (The Ottawa Hospital) physician referral at the Civic campus,” explains Dr. Tad.

There is no set list of causes or treatments for PNES and it is only more recently that some helpful developments have been made. With a proper diagnosis and treatment plan, some people diagnosed with PNES are able to manage their seizures and even become seizure-free.

~ by Leah Burchill

PNES infographic